How Is Acute Low Back Pain Diagnosed?

Woman with back pain
Woman with back pain. WIN-Initiative / Getty Images

If you’ve had lower back pain for less than 6 weeks, it’s considered to be "acute". Getting your spine checked before the 6-week mark is a good idea, as early treatment may help you avoid a long-term chronic back problem (also known as persistent pain.)

How is Acute Low Back Pain Diagnosed?

When you go to the doctor for your back pain, she will conduct a medical interview (called a history) and a physical exam.

The information she gathers at this appointment will help her diagnose your pain by placing you into one of three general categories:

  • Non-specific low back pain
  • Pain directly involving nerves for example, radiculopathy caused by herniated disc.
  • Other causes, also called "red flags." These are serious conditions that may have back pain as a symptom. An example might be a synovial cyst or tumor. If you have a red flag, your doctor will probably order diagnostic tests to try to get to the root of the problem.

Your treatment plan and the decision for any further testing will likely be determined based on the category into which your pain falls.

Believe it or not, your personality, attitude and social conditions play a role in determining how long the pain will last, and how severe it gets. So don’t be surprised if, during your medical interview, your doctor asks you questions related to this. Your doctor will likely use your answers to these questions to evaluate your risk of developing chronic back pain and disability.

About Diagnostic Imaging Tests for Back Pain

Your back problem may or may not require diagnostic testing, such as an x-ray or MRI. If you are sent for one of these tests, keep in mind that they are meant to help the doctor pinpoint locations in your spine that show damage or changes (called lesions) that correspond to your symptoms.

But because most back problems have no specific cause, they often cannot be detected on a film. The exceptions are: You have nerve symptoms, spinal stenosis, or -- based on your history and physical exam -- the doctor thinks a serious underlying health problem is causing your pain. Another reason for diagnostic imaging tests may be if if your doctor asks you to consider surgery or a spinal injection.

And imaging tests are often overused.  A 2011 study found that getting such tests for low back pain did not help the patients feel better or do more, as compared to clinical care that did not involve these tests. As for finding serious underlying problems to your back pain, the study results showed that not getting an imaging test right off the bat did nothing to hinder the doctors from identifying such health conditions in those who were not at risk for them.

As a result of their findings, the study authors concluded that clinical practitioners should "refrain from routine, immediate lumbar imaging in primary care patients with nonspecific, acute or subacute LBP and no indications of underlying serious conditions."

Source:

Andersen J. Is immediate imaging important in managing low back pain? J Athl Train. Jan-Feb. 2011. Accessed: Oct. 2016. https://www.ncbi.nlm.nih.gov/pubmed/21214357

Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK, Clinical Efficacy Assessment Subcommittee of the American College of Physicians, American College of Physicians, American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. Oct 2007. https://www.ncbi.nlm.nih.gov/pubmed/17909209


Fritz, J.M., Delitto, A., Erhard, RE. Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial. Spine. Jul. 2003.

Back pain, acute, low. BMJ Clinical Evidence. https://www.ncbi.nlm.nih.gov/pubmed/12838091

Michigan Quality Improvement Consortium. Management of acute low back pain. Southfield (MI): Michigan Quality Improvement Consortium; March 2008. http://mqic.org/pdf/mqic_management_of_acute_low_back_pain_cpg.pdf

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